血清γ-谷氨酰转肽酶水平与2型糖尿病患者心脑血管疾病风险的前瞻性队列研究

王勉; 范习康; 苏健; 覃玉; 沈冲; 陆艳; 孙中明; 杨婕; 陶然; 周金意; 武鸣

Abstract

王勉,范习康,苏健,覃玉,沈冲,陆艳,孙中明,杨婕,陶然,周金意,武鸣.血清γ-谷氨酰转肽酶水平与2型糖尿病患者心脑血管疾病风险的前瞻性队列研究[J].Chinese journal of Epidemiology,2024,45(10):1339-1347

血清γ-谷氨酰转肽酶水平与2型糖尿病患者心脑血管疾病风险的前瞻性队列研究

Association of serum gamma-glutamyl transferase levels with cardiovascular disease risk in type 2 diabetes patients: a prospective cohort study

Received:June 28, 2024

DOI：10.3760/cma.j.cn112338-20240628-00384

KeyWord: 糖尿病，2型血清γ-谷氨酰转肽酶心脑血管疾病前瞻性研究

English Key Word: Diabetes mellitus, type 2 Serum gamma-glutamyl transferase Cardiovascular disease Prospective study

FundProject:江苏省医学领军人才和创新团队项目（K201105）；江苏省第五期“333工程”科研项目（BRA2020090）；江苏省卫生健康委员会医学科研项目（M2020085，H2023022）；苏州市科技局民生科技-科技示范工程项目（SS202010）

Author Name	Affiliation	E-mail
Wang Mian	School of Public Health, Nanjing Medical University, Nanjing 211166, China
Fan Xikang	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Su Jian	School of Public Health, Nanjing Medical University, Nanjing 211166, China Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Qin Yu	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Shen Chong	School of Public Health, Nanjing Medical University, Nanjing 211166, China
Lu Yan	Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
Sun Zhongming	Huai'an Center for Disease Control and Prevention, Huai'an 223001, China
Yang Jie	School of Public Health, Nanjing Medical University, Nanjing 211166, China Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Tao Ran	School of Public Health, Nanjing Medical University, Nanjing 211166, China Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhou Jinyi	School of Public Health, Nanjing Medical University, Nanjing 211166, China Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Wu Ming	School of Public Health, Nanjing Medical University, Nanjing 211166, China Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	jswuming@vip.sina.com

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Abstract:

目的探讨江苏省2型糖尿病（T2DM）患者血清γ-谷氨酰转肽酶（GGT）水平与心脑血管疾病（CVD）及其亚型发病风险的关联。方法研究对象来自江苏省社区糖尿病综合干预及应用研究，基线调查开展于2013-2014年，随访截至2021年12月31日。剔除基线自报患有慢性肝病/脑卒中/冠心病及GGT信息缺失者，最终纳入16 147名研究对象进行分析。采用Cox比例风险回归模型计算GGT与CVD、心肌梗死和脑卒中发病的风险比（HR）值及其95%CI。运用限制性立方样条模型分析GGT与CVD及其亚型发病风险的剂量反应关系。结果研究对象中位随访时间为8.02年，随访期间共新发2 860名CVD，其中新发196名心肌梗死，2 730名脑卒中。多因素Cox比例风险回归模型结果显示，与GGT最低水平组相比，最高水平组的CVD和脑卒中发病风险分别增加24%（HR=1.24，95%CI：1.09~1.41）和23%（HR=1.23，95%CI：1.08~1.40）。限制性立方样条模型结果显示，T2DM患者中GGT与CVD、心肌梗死和脑卒中呈非线性剂量反应关系。结论较高水平的GGT可能与T2DM患者CVD发病风险升高相关，未来的临床实践中需要进一步探索验证。

English Abstract:

To investigate the associations of serum gamma-glutamyl transferase (GGT) levels with the risk of cardiovascular disease (CVD) and its subtypes in patients with type 2 diabetes mellitus (T2DM) in Jiangsu Province. Methods The participants were enrolled in the Comprehensive Research project regarding 'Prevention and Control of Diabetes' in Jiangsu Province. The baseline survey was conducted from 2013 to 2014, and follow-up until December 31, 2021. After excluding the participants who self-reported with chronic liver disease/stroke/coronary heart disease at baseline survey and those with incomplete information on GGT, a total of 16 147 T2DM patients were included in the final analysis. Cox proportional hazard regression models were used to calculate the hazard ratio (HR) and their 95%CI of GGT for CVD, myocardial infarction, and stroke. Restricted cubic spline models were applied to analyze the dose-response relationship between GGT and the risk of CVD and its subtypes. Results During the median follow-up time of 8.02 years, 2 860 CVD cases were registered, including 196 cases of myocardial infarction and 2 730 cases of stroke. Multivariate Cox proportional risk regression model indicated that compared to the lowest serum GGT level group, the highest GGT level group had a 24% increased risk of CVD (HR=1.24, 95%CI: 1.09-1.41) and a 23% increased risk of stroke (HR=1.23, 95%CI: 1.08-1.40). The restricted cubic spline model showed a nonlinear dose-response relationship between GGT and the risk of CVD, myocardial infarction, and stroke in T2DM patients. Conclusions High levels of GGT may be associated with an increased risk of cardiovascular disease in T2DM patients, which needs further exploration and validation in future clinical practice.

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